Diabetes Mellitus Handout
I.
Endocrine Pancreas
a. Islets of ____________________________
i. __________ cells  _____________________
II.
Insulin:
a. Primary function…
i. Stimulates the ________________________ of glucose from the
_______________ into muscle, liver and adipose tissue  ____ blood glucose
levels
b. Consume ______________  ___________________  ___________stream
i. *________________________ AKA _________________________
1. Simple
2. Complex
c. Is stimulated by ____________________________________
i. ___________________ levels in the bloodstream regulate the _________ of
insulin secretion
d. Major action
i. ___________ blood glucose levels
ii. ___________ the permeability of target cell membranes to ____________
iii. Main target cells _____________________________________________
e. Pathophysiology summary:
i. ______________blood glucose levels  _____________ (gland) _________
cells  ___________________  ___________________ cells (muscles) 
(pulls glucose from the blood into the muscles)  ___________ blood glucose
levels
f.
In the _______________________of insulin, glucose is ___________able to get into the
cells and it is excreted in the ___________________: _______________
g. ______________________cells are not dependent on insulin for glucose intake
h. Function of Insulin
i. Need insulin for __________________ to cross cell membrane
ii. No insulin  no _____________into the _____________
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iii. Glucose stays in the ____________ __________________________
III.
Diagnostic tests
a. Blood glucose / ___________________blood glucose
i. Measures blood __________________levels after ________________
ii. Results
1. Normal : _____________________ mg/dL
2. Diabetic level _________________ mg/dL
3. Critical ______________________ mg/dL
4. Critical ______________________ mg/dL
iii. ______________ 6-8 hours
iv. Water ________________
v. No _______________ or anti-______________________ meds
vi. _________________________ will effect results
b. Glycosylated Hemoglobin Assay
i. ___________________________ of glycosylated hemoglobin
ii. RBC lifecycle : @ _______________ days
iii. _______________slowly binds with ________________  glycosylated
iv. _____________ serum glucose level  _______ glycosylated Hgb levels
v. Provides an _________________blood glucose levels - Past _____months
vi. Results
1. Normal levels (______________________) _________________
2. Diabetic level (goal) __________________
Small Group Questions
1. What are the Islets of Langerhans?
2. What cells of the pancreas secrete insulin?
3. What stimulates insulin to be secreted?
4.
IV.
Diabetes Mellitus
a. Group of disordered characterized by _______________________
b. Due to faulty ______________________ production
i. (Not Diabetes_____________________)
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V.
Type 1 Diabetes Mellitus
a. Pathophysiology
i. ______________________of the Beta cells
ii. Result in ________________ insulin production
iii. Insulin _________________
b. S&S
i. ______________________________: _________ blood glucose levels
1. ________insulin  Glucose stays in the __________________
ii. ______________________________: Glucose in the ______________
iii. ______________________ & _____________________
iv. ______________________________: excessive __________________
v. ______________________________: excessive __________________
vi. ______________________________
1. Skin ______________________
2. ___________________ membranes
3. __________________________
4. ____________ level ______________________________
c. Nursing Diagnosis: ________________________________________________
Small Group Questions
1. Why would a person with high glucose levels have polyphagia?
2. Explain why polyuria is a common symptom of diabetes Mellitus Type 1.
3. What is hyperglycemia?
4. Why does hyperglycemia happen in Type 1 diabetes mellitus?
5. What is a normal level for a FBS?
6. Define the following terms: Glucose, Glycosuria.
7. What does an Hgb A1c measure? What are normal values for a diabetic and non-diabetic?
VI.
Diabetes Mellitus Type 2
a. Pathophysiology
i. The pancreas cannot produce ________________ insulin for __________
ii. _______________________ insulin secretion
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iii. _______________________ beta cells due to _______________________
iv. Not ___________________ clients require ________________________
1. 1/3 will at _________________ time: _______________________
b. Risk Factors
i. _____________________ history
ii. ___________________________
iii. ___________________________ diabetes (______________ baby)
Type 1
Type 2
Age of Onset
Body Wt at onset
Insulin production
Insulin injections
Management
- ______________________
- ______________________
- ______________________
- ______________________
- ______________________
-Possibly _______ hypoglycemic
____________
-Possibly _______________
c. Other types of Diabetes Mellitus
i. ______________________________
ii. ___________________itis
iii. __________ or chemical induced diabetes
d. S&S
i. Definition
1. A group of disorders characterized by ______________________
ii. 3 P’s
1. _____________________________________________________
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iii. S&S by body Systems
Hyperglycemia
Hypoglycemia
Neurological
Cardiovascular
Respiratory
Gastro-Intestinal
Genital-urinary
Skeletal-Muscular
Integumentary
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Small Group Questions
Mr. McMillan is a 50 year old client brough into the ER with extreme fatigue and dehydration.
After the MD sees him the nurses asks Mr. McMillan some additional questions. Based on the clients
answers the nurse requests that the MD add a glucose level to the lab work. The results are 800mg/dL.
1. What question did the nurse most likely ask?
2. Why was Mr. McMillan fatigued?
3. Why was he dehydrated?
VII.
Medical management of DM
a. Overview:
i. No ________________
ii. Goal is____________________ And prevent ______________________
iii. __________________________treatment plans
b. Diet
i. Goals
1. Maintain near-normal ___________________________________
2. Achieve optimal _______________________________________
3. Provide adequate ____________for reasonable _______________
4. Prevent & treat acute _______________of insulin-treated diabetes
5. Improve __________________________through optimal nutrition
ii. The ______________________ System (__________ categories)
1. _____________
4. _____________
2. _____________
5. _____________
3. _____________
6. _____________
iii. General guidelines
1. Percentages
a. Protein__________________
b. Fat_____________________
c. Carbohydrates____________
2. ADA: ____________________________________________
3. ____________________ _______________________ meals
4. ____________________________!
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a. Amount of __________________________
b. Amount of __________________________
c. ______________________
d. ______________________
5. If the client is _____________ the key to treatment is __________
6. Individualized
a. Food ________________________
b. ________________________
c. ________________________
d. _____________ / culture background
7. Alcohol ______________ risk of _______________________
c. Exercise
i. Effect: _______________ blood glucose levels
ii. Benefits
1. Increases __________________________
2. Improve serum _________________levels
3. Improves _________________________status
4. Assist with ______________ control
5. Decreases ___________________
iii. Rules for exercising
1. Talk to ____________________first
2. Regular vs. sporadic
3. Correlate ________________and _______________levels
4. Don’t exercise when _____________________________
5. Don’t exercise when _____________________________
6. Do not exercise when insulin is ____________________
7. Carry a ________________source of sugar
8. Best time = ______________________ after a _____________
9. Proper ______________________
10. May need a pre-exercise ___________________
11. ______________________________ !
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iv. Monitoring Glucose
1. _______________________________: _____________________
Small Group Questions
1. Give signs & symptoms of hyperglycemia by body system (Why do they manifest these
symptoms?)
2. A diabetic meal plan’s main goal is to maintain near normal glucose levels. How is this done?
3. The exchange diabetic meal plan is divided into six categories, what are they?
4. What affect does alcohol have on a diabetic?
5. What affect does exercise have on a diabetic?
6. What council would you give a diabetic regarding exercise?
d. Medications
i. Key terms
1. ______________: The time period from ______________to when it
________________to take effect
2. ______________: When insulin is working its _______________ and
therefore blood glucose levels are at their ________________
3. ______________: Length of time the insulin ___________or lasts
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VIII.
Insulin
Appearance
Onset
Peak
Duration
Very short acting
Lispro (Humalog)
Aspart (Novolog)
Nursing Implications
Short-acting / Regular
Novolin R
Humulin R
Nursing Implications
Intermediate-acting
NPH
Humulin N
Novolin N
Nursing Implications
a. Learning Tip
i. Short acting think _____________ (_________________)
ii. Intermediate-acting think _____________ (________________)
b. When should insulin be administered?
i. Short-acting / regular: _________________________________
1. Do not allow more than _______to pass by without eating
2.  _____________________
ii. Intermediate acting: ______________________meals
iii. If mixed (regular & intermediate): ____________________ meals
c. Route for insulin
i. _____________________: _________________
ii. _______________________________________
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1. Syringe: ____________________: ____________guage
2. Pinch an inch _____________________________
3. Can’t pinch and inch: ______________________
4. Area’s of injections:
a. ___________
b. ___________
c. ___________
d. ___________
5. Pumps: S/E risk ________________________________
Small Group Questions
Mrs. Evans is 60 year old women with type 2 DM. She is on Intermediate Acting Insulin [Novolin N ]
every morning. She normally eats her meals at 8:00 AM, 12:00 PM, and 6:00 PM.
1. What time should she take her morning insulin?
2. When will this dose onset?
3. When will this does peak?
4. What does this insulin look like?
Mrs. Sweet Peas takes 13 units of Short-Acting Insulin [Humalog R] q ac. Her meals are B-8:00 AM,
L-12:00 PM, D-7:00PM
1. What time should Mrs. Peas take her mid-day (lunch)dose of insulin?
2. When this dose onset?
3. When will this dose peak?
4. What does this insulin look like?
iii. Mixing Insulin: How to
1. __________________ equipment
a. Insulin, Syringe, Alcohol swab, MD _____________
2. Check MD order for ________________ and ____________
3. __________________ the bottle of intermediate acting insulin (DO
NOT_______________________)
4. __________________ the top of both vials with alcohol swab
5. Draw up and inject an amount of ____________equal to the dose of
__________________acting insulin into the ___________vial. Then
___________________syringe from the vial
6. Draw up and inject an amount of _______________equal to the amount of
_____________-acting insulin into the _________ vial. *Then
_________________ syringe in the vial
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7. Draw up the correct amount of _______________________insulin
8. ______________check with another nurse
9. Remove the syringe and insert into the ________________vial. Carefully
draw up the correct amount of insulin
10. ________________check with another nurse _________removing the syringe
from the vial
iv. Sliding Scale
1. Used during: __________________________________________
2. Determines insulin dose based on ___________________
3. FSBS check usually every ______________________ hrs
4. Usually ____________________________insulin is used
5. Sample Sliding Scale
Check FSBS before meals and at HS (2200)
- 4u Humulin R insulin for glucose 151-200 mg/dL
- 6u Humulin R insulin for glucose 201-250 mg/dL
- 8u Humulin R insulin for glucose 251-300 mg/dL
- 10u Humulin R insulin for glucose 301-350 mg/dL
- Call MD for glucose >350 mg/dL
v. Pre-mixed insulin
1. ___________________+_______________________
a. Novolin 70/30
b. 70% __________________
c. 30% __________________
vi. Insulin Storage
1. Vial not being used ________________
2. Vial in use  __________________temperature
3. Storage life un-refrigerated = ______________________
vii. Insulin Complications : S/E
1. #1 ___________________________
2. Causes
a. Too much ____________________
b. Too little _____________________
c. Extreme _____________________
3. S&S (see chart page5)
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Small Group Questions
1. When is a sliding scale commonly used?
2. A tuberculin syringe is also calibrated in units. Is it OK to use a TB syringe to draw up
insulin?
3. What route is insulin administered?
4. Compare the signs and symptoms of hyper and hypoglycemia
5. How come they are not all opposite signs and symptoms?
6. Why are some so similar?
7. Which symptoms can you look for to tell the difference between hyper and
hypoglycemia? (*)
8. What is the biggest risk factor in using an insulin pump?
IX.
Oral Hypoglycemic Agents
Cholpropamide (Diabanese)
Glipizide (Glucotrol)
Glimepride (Amaryl)
Glyburide (Diabeta, Micronase)
Metformin (Glucophage)
Sulfonylurea
Biguanides
a. Rules
a. Oral hypoglycemic meds are not _____________________
b. Oral hypoglycemic meds require some ___________________of insulin
c. Oral hypoglycemic agents are used in the treatment of type ______DM
d. Oral hypoglycemic meds are meant to _______________diet and exercise, not
_____________________them
e. Oral hypoglycemic meds cannot be used during _____________________
f.
Oral hypoglycemic meds may need to be ______________temporarily and
________________prescribed if BS levels rise due to stress or illness etc.
g. Action varies so effect may be enhanced by use of ______________meds
b. Sulfonylurea’s
a. Sulfonylurea’s work primarily by ____ the secretion of ____________by directly
stimulating the _______________________
b. S/E _______________________________________________________
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c. Biguanides
a. work primarily by aiding insulin’s action on _______________________
b. Biguanides are NOT associated with episodes of ___________________
c. Biguanides_______ sulfonylurea may ______ the glucose lowering effect
d. S/E _____________________________________________________
e. Contraindicated in patients with _______________________________
d. Can Diabetes pills help me?
a. Only _____________________DM
b. Results __________________
c. Effectiveness ______________________
d. _____________________may still need to be taken occasionally
e. Pregnant… _________________________
Small Group Questions
1. A type 1 DM asks you “Why do I have to have insulin injections, why can’t I just take the Insulin
pills?” How would you answer him?
2. Mrs. Murdock is a Type 2 DM. She was taking Glucatrol 20 mg BID. The MD changed her meds
today to Micronase 5 mg PO BID and Glucophage 500 mg PO BID. Mrs. Murdock asks you why
she is taking two medications now, instead of just increasing the dose of Glucatrol?
X.
Treatment of complications of Diabetes Mellitus
a. Hypoglycemia
i. Definition: When blood glucose levels fall below ____________ mg/dL
1. < __________________mg/dl = severe
ii. Etiology
1. _______________ time
2. Usually: _____________________ meals or a _____________________
3. ________________________ insulin or oral hypoglycemic meds
4. ________________________ food
5. Excessive __________________________
iii. Diagnosis
1. __________________
a. Can occur ______________________________
b. If client long time diabetic  ___________________S&S
2. ___________________________: _________________________
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iv. Actions:
1. Assess for ________________
2. ___________ blood sugar level
3. Administer _______________________
a. _____________ fast acting carbohydrate
b. Do not add _________________to OJ
c. Recheck FSBS ______________________until WNL
d. Avoid high __________________ slows absorption of glucose
e. Instruct: ________________________fast sugar
f.
_______________________if “unconscious” or confused
g. If meal is >1 hr away, follow with a __________________ and
_____________________carbohydrate
4. Gerontological Considerations
a. Cognitive deficits  not recognize __________________
b. Decreased _________________function  oral hypoglycemic
meds stay in body longer
c. More likely to _________a meal
d. _________________problems  inaccurate insulin draws
5. Nursing measures
a. Follow ____________________
b. Teach
i. _______________simple sugar at all times
ii. _______________or hypoglycemia
iii. How to ________________Hypoglycemia
iv. Check ____________if you suspect  _________
b. Hyperglycemia
i. Treatment
1. Assess for ____________________
2. Check _______________________
3. Administer ____________________
4. Monitor fluid and electrolytes:
a. Esp _________ & ______________ fluids
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